Postoperative Outcomes in Surgical COVID-19 Patients: A Multicenter Cohort Study

Abstract

BackgroundData on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who undergone a surgery and the pandemic impact on surgical activities.MethodsWe conducted a multicenter cohort study between March 13 and June 19 2020. We included COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and overall surgical activities performed in participating centres. Our primary outcome was 30-day mortality. ResultsWe included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was 15.9%. This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22 616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44 486 cases).Conclusion In this study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was 15.9%. Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. Trial registrationClinicalTrials.gov Identifier: NCT04458337

Targeted coronavirus disease 2019 (COVID-19) surveillance for elective procedures: Lessons for resource conservation during a pandemic and beyond

“…9,10 Additionally, 30-day mortality has been shown to be lower in asymptomatic COVID-19 patients undergoing surgery (5.6%, compared to 23.1% in symptomatic patients; P = .118). 10 These data support the assumptions upon which our protocol was based.…”

The influence of SARS‐CoV‐2 vaccination on post‐operative outcomes in microsurgery patients

“…Outside of microsurgery, SARS‐CoV‐2‐postive surgical patients have been found to be at increased risk for morbidity and mortality in the post‐operative period relative to SARS‐CoV‐2‐negative patients (Carrier et al, 2021; Collaborative CO, 2020b; Covidsurg Collaborative GC, 2021; Doglietto et al, 2020; El‐Boghdadly et al, 2021; Haffner et al, 2021; Katsiampoura et al, 2020; Phelps et al, 2020; Prasad et al, 2021). Specifically, the international COVIDSurg Collaborative demonstrated that pre‐operative SARS‐CoV‐2‐vaccination led to reduced risk of both post‐operative morbidity and mortality in SARS‐CoV‐2‐positive surgical patients (Collaborative CO, 2020b).…”

“…Aside from its impact on pre‐operative management and procedure selection, SARS‐CoV‐2 may also negatively impact surgical outcomes (Katsiampoura et al, 2020; Phelps et al, 2020). Previous studies have shown that 30‐day mortality and complications, including thrombosis, are significantly increased in patients who have undergone surgery while infected with COVID‐19 (Carrier et al, 2021; Doglietto et al, 2020). More specifically, prior studies have shown that SARS‐CoV‐2 may increase risk for thrombotic events via induction of a pro‐coagulable state which, when combined with the pro‐inflammatory environment induced by surgery, can contribute to formation of deep vein thrombi, pulmonary emboli, and large vessel strokes (Abou‐Ismail et al, 2020; Janardhan et al, 2020; Mucha et al, 2020; Zapata et al, 2020).…”

Risk Factors Associated With Postoperative Mortality Among COVID-19 Positive Patients: Results of 3027 Operations and Procedures

“…We found the postoperative 30-day mortality rate to be 4.01%, which was lower than the previous studies reporting mortality rates ranging from 14.7% to 27.3%. [4][5][6][7][8][9][10][11][12] We believe that this difference can be explained by the differences in the study periods, as well as better understanding of the care of patients with COVID-19 and development of perioperative management protocols over time. As our study included patients who had interventions in the height of the pandemic (January 2020 to March 2021), we were able to include a possibly larger proportion of patients who were vaccinated and as a result had asymptomatic/milder disease.…”